Healthcare Provider Details

I. General information

NPI: 1982908497
Provider Name (Legal Business Name): DURA-MED SOUTHEAST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3877 HWY 4
JAY FL
32565
US

IV. Provider business mailing address

PO BOX 640
JAY FL
32565-0640
US

V. Phone/Fax

Practice location:
  • Phone: 850-675-6850
  • Fax: 850-675-6805
Mailing address:
  • Phone: 850-675-6850
  • Fax: 850-675-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MISTY HERRING
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 850-675-6850